TEST BANK For Advanced Health Assessment and Differential
Diagnosis Essentials for Clinical Practice 1st Edition Myrick
1. What is the best follow-up question for someone who tells you that the pain is
constant?
a. can you use one finger to point to the pain location?
b. do you have the pain right now?
c. does the pain wake you up at night after you have fallen asleep?
d. Is there anything that makes the better better or worse? - ANSWER:b. do you have
the pain right now?
2. 52-year-old woman with shoulder pain tells you that she has pain at night that
awakens her. After asking a series of follow-up questions, you are able to determine
that she had trouble falling asleep because her pain increases when she goes to bed.
Once she falls asleep, she wakes up as soon as she rolls onto that side. What is the
most likely explanation for this pain behavior?
a. Minimal distractions heighten a person's awareness of musculoskeletal
discomfort.
b. This is a systemic pattern that is associated with a neoplasm.
c. It is impossible to tell.
d. This represents a chronic clinical presentation of a musculoskeletal problem. -
ANSWER:a. Minimal distractions heighten a person's awareness of musculoskeletal
discomfort.
3. Referred pain patterns associated with impairment of the spleen can produce
musculoskeletal symptoms in:
a. left shoulder
b. right shoulder
c. mid-back or upper back, scapular, and right shoulder areas
d. thorax, scapulae, right shoulder, or left shoulder - ANSWER:a. left shoulder
4. Associated signs and symptoms are a major red flag for pain of a systemic or
visceral origin compared to musculoskeletal pain.
a. true
b. false - ANSWER:a. true
5. Words used to describe neurogenic pain often include:
a. throbbing, pounding, beating
b. crushing, shooting, pricking
c. aching, heavy, sore
,d. agonizing, piercing, unbearable - ANSWER:b. crushing, shooting, pricking
6. Pain (especially intense bone pain) that is disproportionately relieved by aspirin
can be a symptom of:
a. neoplasm
b. assault or trauma
c. drug dependence
d. fracture - ANSWER:a. neoplasm
7. Joint pain can be a reactive, delayed, or allergic response to:
a. medications
b. chemicals
c. infections
d. artificial sweeteners
e. all the above - ANSWER:e. all the above
8. Bone pain associated with neoplasm is characterized by:
a. increases with weight bearing
b. negative heel strike
c. relieved by turns or other antacid in women
d. goes away after eating - ANSWER:a. increases with weight bearing
9. A 48 year old man presented LBP of unknown cause. He works as a carpenter and
says he is very active, has work related mishaps, and engage in repetitive motions of
all kinds using his arms, back, and legs. The pain is intense when he has it, but it
seems to come and go. He is not sure if eating makes the pain better or worse. He
has lost his appetite because of the pain. After conducting an examination including
a screening exam, the clinical presentation does not match the expected pattern for
a musculoskeletal or neuromuscular problem. You refer him to a physician for
medical testing. You find out later he had pancreatitis. What is the most likely
explanation for this pain pattern.
a. toxic waste products from the pancreas are released into the intestines causing
irritation of the retroperitoneal space
b. rupture of the pancreas causes internal bleeding and referred pain called Kehr's
sign
c. the pancreas an - ANSWER:d. obstruction, irritation, or inflammation of the body
of the pancreas distends the pancreas, thus applying pressure on the central
respiratory diaphragm.
10. Pulse strength graded as 1 means:
a. easily palpable, normal
b. present occasionally
, c. pulse diminished, barely palpable
d. within normal limtis - ANSWER:c. pulse diminished, barely palpable
11. During auscultation of an adult client with rheumatoid arthritis, the heart rate
gets stronger as she breathes in and decreases as she breathes out. This sign is:
a. characteristic of lung disease
b. typical in coronary artery disease
c. a normal finding
d. common in anyone with pain - ANSWER:c. a normal finding
12. how do you plan or modify an exercise program for a client with cancer without
the benefit of blood values? - ANSWER:First of all, do you need to? How far out from
the first medical diagnosis and final treatment is the client? Is the client still being
treated? Without laboratory values, physical assessment becomes much more
important. Check vital signs; observe the skin, eyes, and nailbeds, and ask about the
presence of associated signs and symptoms.
13. When would you consider listening for femoral bruits? - ANSWER:Bruits are
abnormal blowing or swishing sounds heard on auscultation of narrowed or
obstructed arteries. Bruits with both systolic and diastolic components suggest the
turbulent blood flow of partial arterial occlusion that is possible with aneurysm or
vessel constriction. The therapist is most likely to assess for bruits when the client or
patient is older than 65 years of age and describes problems (i.e., neck, back,
abdominal, or flank pain) in the presence of a history of syncopal episodes, a history
of cardiovascular disease (CVD), serious risk factors for CVD, or a previous history of
aortic aneurysm. Look for other signs of peripheral vascular disease that may
account for the client's current symptoms. Symptoms may be described as
"throbbing" and may increase with activity and decrease with rest. In the most likely
candidate, neck or back pain is not affected by physical therapy intervention. The
client is an older adult, a postmenopausal woman, and/or has significant risk factors
for CVD or a history of CVD.
14. A 23-year-old female presents with new onset of skin rash and joint pain
followed by 2 weeks later by GI sx of abdominal pain, nausea, and diarrhea. She has
previous hx of Crohn's disease, but this condition has been stable for several years.
She does not think her current sx are related to her Crohn's disease. What kind of
screening assessment is needed in this case?
a. vital signs only
b. vital signs and abdominal auscultation
c. vital signs, neurologic screening examination, and abdominal auscultation
d. no further assessment is needed, there are enough red flags to advise this client to
seek medical attention - ANSWER:d. no further assessment is needed, there are
enough red flags to advise this client to seek medical attention
Diagnosis Essentials for Clinical Practice 1st Edition Myrick
1. What is the best follow-up question for someone who tells you that the pain is
constant?
a. can you use one finger to point to the pain location?
b. do you have the pain right now?
c. does the pain wake you up at night after you have fallen asleep?
d. Is there anything that makes the better better or worse? - ANSWER:b. do you have
the pain right now?
2. 52-year-old woman with shoulder pain tells you that she has pain at night that
awakens her. After asking a series of follow-up questions, you are able to determine
that she had trouble falling asleep because her pain increases when she goes to bed.
Once she falls asleep, she wakes up as soon as she rolls onto that side. What is the
most likely explanation for this pain behavior?
a. Minimal distractions heighten a person's awareness of musculoskeletal
discomfort.
b. This is a systemic pattern that is associated with a neoplasm.
c. It is impossible to tell.
d. This represents a chronic clinical presentation of a musculoskeletal problem. -
ANSWER:a. Minimal distractions heighten a person's awareness of musculoskeletal
discomfort.
3. Referred pain patterns associated with impairment of the spleen can produce
musculoskeletal symptoms in:
a. left shoulder
b. right shoulder
c. mid-back or upper back, scapular, and right shoulder areas
d. thorax, scapulae, right shoulder, or left shoulder - ANSWER:a. left shoulder
4. Associated signs and symptoms are a major red flag for pain of a systemic or
visceral origin compared to musculoskeletal pain.
a. true
b. false - ANSWER:a. true
5. Words used to describe neurogenic pain often include:
a. throbbing, pounding, beating
b. crushing, shooting, pricking
c. aching, heavy, sore
,d. agonizing, piercing, unbearable - ANSWER:b. crushing, shooting, pricking
6. Pain (especially intense bone pain) that is disproportionately relieved by aspirin
can be a symptom of:
a. neoplasm
b. assault or trauma
c. drug dependence
d. fracture - ANSWER:a. neoplasm
7. Joint pain can be a reactive, delayed, or allergic response to:
a. medications
b. chemicals
c. infections
d. artificial sweeteners
e. all the above - ANSWER:e. all the above
8. Bone pain associated with neoplasm is characterized by:
a. increases with weight bearing
b. negative heel strike
c. relieved by turns or other antacid in women
d. goes away after eating - ANSWER:a. increases with weight bearing
9. A 48 year old man presented LBP of unknown cause. He works as a carpenter and
says he is very active, has work related mishaps, and engage in repetitive motions of
all kinds using his arms, back, and legs. The pain is intense when he has it, but it
seems to come and go. He is not sure if eating makes the pain better or worse. He
has lost his appetite because of the pain. After conducting an examination including
a screening exam, the clinical presentation does not match the expected pattern for
a musculoskeletal or neuromuscular problem. You refer him to a physician for
medical testing. You find out later he had pancreatitis. What is the most likely
explanation for this pain pattern.
a. toxic waste products from the pancreas are released into the intestines causing
irritation of the retroperitoneal space
b. rupture of the pancreas causes internal bleeding and referred pain called Kehr's
sign
c. the pancreas an - ANSWER:d. obstruction, irritation, or inflammation of the body
of the pancreas distends the pancreas, thus applying pressure on the central
respiratory diaphragm.
10. Pulse strength graded as 1 means:
a. easily palpable, normal
b. present occasionally
, c. pulse diminished, barely palpable
d. within normal limtis - ANSWER:c. pulse diminished, barely palpable
11. During auscultation of an adult client with rheumatoid arthritis, the heart rate
gets stronger as she breathes in and decreases as she breathes out. This sign is:
a. characteristic of lung disease
b. typical in coronary artery disease
c. a normal finding
d. common in anyone with pain - ANSWER:c. a normal finding
12. how do you plan or modify an exercise program for a client with cancer without
the benefit of blood values? - ANSWER:First of all, do you need to? How far out from
the first medical diagnosis and final treatment is the client? Is the client still being
treated? Without laboratory values, physical assessment becomes much more
important. Check vital signs; observe the skin, eyes, and nailbeds, and ask about the
presence of associated signs and symptoms.
13. When would you consider listening for femoral bruits? - ANSWER:Bruits are
abnormal blowing or swishing sounds heard on auscultation of narrowed or
obstructed arteries. Bruits with both systolic and diastolic components suggest the
turbulent blood flow of partial arterial occlusion that is possible with aneurysm or
vessel constriction. The therapist is most likely to assess for bruits when the client or
patient is older than 65 years of age and describes problems (i.e., neck, back,
abdominal, or flank pain) in the presence of a history of syncopal episodes, a history
of cardiovascular disease (CVD), serious risk factors for CVD, or a previous history of
aortic aneurysm. Look for other signs of peripheral vascular disease that may
account for the client's current symptoms. Symptoms may be described as
"throbbing" and may increase with activity and decrease with rest. In the most likely
candidate, neck or back pain is not affected by physical therapy intervention. The
client is an older adult, a postmenopausal woman, and/or has significant risk factors
for CVD or a history of CVD.
14. A 23-year-old female presents with new onset of skin rash and joint pain
followed by 2 weeks later by GI sx of abdominal pain, nausea, and diarrhea. She has
previous hx of Crohn's disease, but this condition has been stable for several years.
She does not think her current sx are related to her Crohn's disease. What kind of
screening assessment is needed in this case?
a. vital signs only
b. vital signs and abdominal auscultation
c. vital signs, neurologic screening examination, and abdominal auscultation
d. no further assessment is needed, there are enough red flags to advise this client to
seek medical attention - ANSWER:d. no further assessment is needed, there are
enough red flags to advise this client to seek medical attention
